Active NPI
Revive Psychological Services P.C.
- Clinical Psychologist
- Woodridge, IL
National Provider Identifier
1407146376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071008111
- Legal business name
- REVIVE PSYCHOLOGICAL SERVICES P.C.
- Practice address
- 1420 Tower Hill Dr
Woodridge, IL 60517-7674 - Phone
- (312) 961-1557
- NPI assigned
- Apr 13, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Geetha Munisamy, PH.D.
- Title
- Director
- Phone
- (312) 961-1557
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071008111 | IL | Primary |
Addresses
Primary practice location
1420 Tower Hill Dr
Woodridge, IL 60517-7674
Mailing address
1420 Tower Hill Drive
Woodridge, IL 60517-7674
Phone (312) 961-1557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
2829 83rd St
Darien, IL 60561
Phone (312) 369-9908
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
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- Darien, IL
- NPI 1811567647
-
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- Wheaton, IL
- NPI 1881226439
-
- Mental Health Counselor
- Joliet, IL
- NPI 1699184002
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302652800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1302652800000",
"number": "1407146376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 TOWER HILL DRIVE",
"city": "WOODRIDGE",
"state": "IL",
"postal_code": "605177674",
"telephone_number": "312-961-1557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 TOWER HILL DR",
"city": "WOODRIDGE",
"state": "IL",
"postal_code": "605177674",
"telephone_number": "312-961-1557"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVIVE PSYCHOLOGICAL SERVICES P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2011-04-13",
"last_updated": "2011-04-13",
"status": "A",
"authorized_official_last_name": "MUNISAMY",
"authorized_official_first_name": "GEETHA",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "312-961-1557",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PH.D."
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071008111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.